| NPI | 1730861733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0998487-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0998487-NP) |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2024-10-14 |